Crunching Numbers, Saving Lives

Nicolas Foss, Ed.D., MS

2025-10-20

Objectives

Today we will look at…

  • Reintroduce NEMSQA and its measures
  • Iowa NEMSQA measure performance 2021-2024
  • Discuss trends, geographic distribution
  • Takeaways given performance, considerations of data limitations

Accessing this presentation

QR Code for the slides to this presentation.

Achievements

Here, we will review:

  • Airway-18 (Waveform Capnography Use for Airway Confirmation)
  • Asthma-01 (Beta Agonist Administration for Asthma)
  • Hypoglycemia-01 (Treatment of Symptomatic Hypoglycemia)
  • Safety-01 (Non-Use of Lights and Sirens During Response)

Achievements

Here, we will review:

  • Safety-02 (Non-Use of Lights and Sirens During Transport)
  • Trauma-01 (Pain Assessment in Trauma Patients)
  • Trauma-03 (Pain Reduction Achieved)

Airway-18

This process measure tracks the use of waveform capnography for confirming and monitoring advanced airway placement.

A statistical table showing Iowa performance on the Airway-18 NEMSQA measurefor the years 2021-2024.

Asthma-01

Hypoglycemia-01

Safety-01

Safety-02

Trauma-01

Trauma-03

Gaps

Here, we will review:

  • Airway-01 (First-Attempt Advanced Airway Success)
  • Airway-05 (Preoxygenation Prior to Intubation)
  • Pediatrics-03b (Documentation of Weight for Weight-Based Medications)
  • Respiratory-01 (Assessment of Respiratory Distress)
  • Respiratory-02 (Oxygen Administration for Hypoxia)

Gaps

…in addition:

  • Safety-04 (Pediatric Restraint Use During Transport)
  • Seizure-02 (Benzodiazepine Administration for Status Epilepticus)
  • Stroke-01 (Stroke Assessment in Suspected Stroke Patients)
  • Syncope-01 (ECG Performed for Syncope)

Gaps

…along with:

  • Trauma-04 (Transport to a Trauma Center)
  • Trauma-08 (Trauma Vital Signs Documentation)
  • Trauma-14 (Pre-Arrival Trauma Alerts)
  • TTR-01 (Vital Signs for Non-Transported Patients)
  • TBI-01 (Documentation of Key Physiological Parameters)

Airway-01

This outcome measure assesses the percentage of EMS responses initiated through a 911 call in which advanced airway placement was successful on the first attempt without documented episodes of hypotension or hypoxia during the peri-intubation period.

A statistical table showing Iowa performance on the Airway-01 NEMSQA measurefor the years 2021-2024.

Airway-05

Pediatrics-03b

Respiratory-01

Respiratory-02

Takeaways

  • Demonstrates national leadership in operational safety practices
    • Significant reduction in lights and sirens use during both response and transport
  • Leads peer states in waveform capnography adoption

Takeaways

  • Excels in clinical care performance
    • Strong results in asthma treatment and hypoglycemia management
    • Slightly exceeds national averages in trauma pain assessment
  • Evidence of a strong commitment to quality improvement across agencies

Takeaways

  • Key gaps in clinical performance:
    • Airway management, trauma triage, stroke care, seizure treatment, syncope evaluation
    • Persistent pediatric care and documentation deficiencies

Takeaways

  • Data completeness and accuracy remain limiting factors for system improvement
    • Many EMS professionals record critical details only in narratives, not in discrete data fields
    • Transitioning from narrative-heavy to structured documentation is essential for valid performance measurement

Strategic Priorities

Iowa’s proven record of progress positions it well for future EMS quality gains

  • Expand clinical education and simulation-based training
  • Reinforce standardized EMS protocols statewide
  • Address pediatric care disparities directly

Strategic Priorities

Iowa’s proven record of progress positions it well for future EMS quality gains

  • Improve EMS data quality: transition from narrative-heavy documentation to structured, discrete data fields for accurate performance measurement
  • Modernize and strengthen EMS data infrastructure

Analyses

At BEMTS, we have been hard at work creating open source software that benefits Iowans and other jurisdictions.

{nemsqar} package page

QR Code for the traumar R statistical computing package GitHub repository.

Questions?

Thanks!

Nicolas Foss, Ed.D., MS

Epidemiologist

Bureau of Emergency Medical and Trauma Services

Bureau of Health Statistics

Division of Public Health > Iowa HHS

C: 515.985.9627 || E: nicolas.foss at hhs.iowa.gov